Guest Column
| July 5, 2017

Whatever the future holds for the Affordable Care Act (ACA), the move from fee-for-service to value-based reimbursements is expected to continue. As this shift to alternative payment models continues, healthcare organizations are seeking ways to get the most out of whichever value-based contract they adopt.

Despite the uncertainties over what’s coming next, healthcare organizations can continue to prepare while also improving their value-based contract performance.

Taking a data-driven approach to value-based payments is an important first step. As healthcare organizations including payers, Accountable Care Organizations (ACOs), and physician groups transition to value-based payment models, comparative analytics provides a view into care costs across multiple care settings, allowing the variations in treatment choices and intensity to be measured and analyzed — giving payers the data they need to make improvements and reduce costs. Comparative analytics can help simplify the management of value-based payment models.

Payers considering methods to help improve value-based contract performance should leverage comparative analytics as one aspect in implementing a data-driven approach to value-based payments. Comparative analytics can help payers:

Identify specific referral patterns that are driving higher costs.

Determine where and how to reduce the cost of care, and share that information.

Redirect providers to lower-cost sites of service and refer patients to lower cost providers.

Provide data to contain costs and meet financial targets such as business goals and bonuses.

With the growth in adoption of bundled payments, the application of comparative analytics can help guide payers toward identifying the greatest opportunities to impact cost of care. By examining historical claims data, payers can identify their highest volume and highest cost procedures (grouped by episodes of care) to establish actual prices as they seek to maximize the performance of value-based contracts.